Provider Demographics
NPI:1275705501
Name:ADVANCED MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BHAJANLAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:DARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-531-1112
Mailing Address - Street 1:1234 LAY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1872
Mailing Address - Country:US
Mailing Address - Phone:314-323-4492
Mailing Address - Fax:800-469-1494
Practice Address - Street 1:4100 UNION BLVD UNIT B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63115-1225
Practice Address - Country:US
Practice Address - Phone:314-531-1112
Practice Address - Fax:314-288-0674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty